THE EFFECT OF TRIPLE THERAPY ON RAPIDLY PROGRESSIVE TYPE OF HENOCH-SCHONLEIN NEPHRITIS

Twelve patients with Henoch-Schonlein purpura, aged 6-14 years (mean 1 0.3 years), presenting with rapidly progressive glomerulonephritis (RP GN) were investigated prospectively. Analysis of the initial clinical features revealed: oedema (8 patients), hypertension (7 patients), gro ss haematuria (11 patients), oliguria (5 patients) and a decreased glo merular filtration rate (GFR) (<40 ml/min per 1.73 m(2), 8 patients). Renal biopsies were available in 9 patients and revealed focal necroti sing and a fibroepithelial type of crescentic glomerulonephritis (with 60%-90% crescent formation). The remaining 3 patients fulfilled the c linical criteria of RPGN. Two patients who were in the acute stage req uired peritoneal dialysis for a period of 2 weeks. The treatment proto col in all patients consisted of intravenous pulse methylprednisolone (3 days), oral cyclophosphamide (2 months), oral dipyridamole (6 month s) and oral prednisolone (3 months). At the end of triple therapy, GFR returned to normal in all but 1 patient. During a follow-up period of 9-39 months, 7 patients achieved complete remission, while 4 patients showed partial remission, 3 of whom had persistent proteinuria and ha ematuria and 1 microscopic haematuria only. One patient had persistent nephropathy with decreased GFR and macroscopic haematuria and nephrot ic-range proteinuria. His renal biopsy, performed 30 months after the onset of the disease, showed chronic diffuse sclerosing glomerulonephr itis and intratubular severe IgA deposition. Although our patient grou p was small, this type of intensive treatment appears to be effective; further studies are needed.